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Positive attitudes are good medicine in pregnancy
Optimism is a strong tonic for women at risk of delivering low-birth-weight or premature babies. In fact, the strong association between positive birth outcomes and optimistic attitudes during pregnancy surprises even Bruce Meyer, MD, a veteran researcher in prenatal behavioral health issues. "Speaking as an insider in the medical profession, I can tell you that the study of mind/body interactions is not considered the ultimate in mainstream medical research," notes the chair of the Department of Obstetrics and Gynecology at the University of Massachusetts Medical School in Worcester.
He advises clinicians to pay attention to this dimension of health, nonetheless. "There is a widespread dissatisfaction with mainstream medicine, and that leads people to alternative therapies regardless of whether we have substantiated that these therapies do any good for our patients, or whether they actually do harm."
In one of their studies,1 Meyer and colleagues found a strong correlation between a woman’s view of her life and the reduced chances of delivering a low-birth-weight or premature baby: The least optimistic women delivered lower-birth-weight babies, while pregnant women with higher optimism scores were more likely to exercise and eat nutritious foods during pregnancy and deliver healthier babies.
Even though less optimistic women report greater stress during pregnancy, stress alone is not the culprit. It’s more the woman’s outlook on her life and the health behaviors practiced during pregnancy that influence birth outcomes. Meyer notes that the increased experience of stress could result from low optimism. The findings suggest that the absence of optimism may be as important to maternal and fetal health as clinical risk.
The connection isn’t magical. More optimistic women followed healthier lifestyles, which improved the odds for full-term pregnancies. "Since optimism is learned behavior," explains Meyer, "the next research question is whether learned optimism can enhance birth outcomes as much as innate optimism."
As providers await the verdict on that question, however, there’s plenty of known science to practice more earnestly. "We can give our patients reason for hope," Meyer explains. "We can teach them that if they eat right and exercise and get regular prenatal care, somewhere in that interaction of things is a good chance that their pregnancy will turn out better."
However, he laments that health care providers still see too many women too late for prenatal health improvement. He urges obstetrical service practitioners to reach out through community resources that can inform expectant mothers about the importance of prenatal care. "There is nobody in this country who does not have access to prenatal care, if not through private insurance, then through Medicaid," Meyer says. "And while Medicaid may not pay for a lot of other things, it does pay providers for prenatal care."
While some practitioners don’t buy the mind/body connection, neonatologists are an exception. Meyer suggests that this comes from their familiarity with the association between a newborn’s well-being and environmental effects such as soft sounds, dim lights and gentle touch.
Neonatologist R. Sue Broyles, MD, describes Meyer’s findings as credible. A member of the comprehensive follow-up team for high-risk infants at Children’s Medical Center in Dallas, Broyles takes it one step further. She explains that the effect of maternal optimism applies after delivery as well.
Her observations are based on her work with high-risk newborns during the first three years of their lives. "There are high rates of depression in the moms who are mostly teenagers. Part of the issue is poverty, and they see no way out. That alone complicates their chance of making something better of their lives. They have few plans to finish high school; they figure they’ll go along with whatever happens.
"We figure that if a mom has no hope for her future, then she has no hope for her baby’s future, either. So for years, we’ve tried to target them with education and parenting skills. We teach them what to expect as normal developmental behaviors in their babies. We counsel them in life-planning issues to help them avoid depression and improve their lives," Broyles adds.
Sally Adams, MS, RN, CPNP, nurse practitioner and co-worker of Broyles, sees a strong connection between religious beliefs and optimism in the mothers of high-risk infants. Family support also helps. Adams explains that her clients are predominantly African American and Hispanic.
She adds that, in some populations, religious factors may even outweigh maternal optimism as a predictor of a mother and child’s well-being.
Meyer suggests that practitioners of Western medicine might be able to help their patients more if they would pause from time to time and take to heart the observations of Navajo Indian healers: "They tell us that we’re brilliant at treating a broken ankle, but not at treating the person with the broken ankle. The Navajo healer treats the person with the broken ankle. The difference is that in just treating the broken ankle, we miss how the person’s life affects the healing of the ankle, or how the injury affects the person’s life." In terms of maternal and infant health, he says, there might be things in a woman’s life that could bolster her optimism. Those intangibles could serve as powerful adjuncts to medical interventions.
1. Lobel M, DeVincent CJ, Kaminer A, et al. The impact of prenatal maternal stress and optimistic disposition on birth outcomes in medically high-risk women. Health Psychol 2000; 19(6):586-595.
For more on incorporating behavioral health elements in prenatal care, contact:
- Bruce A. Meyer, MD, Chair, Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester. E-mail: firstname.lastname@example.org.